RU2668700C2 - Surgical stapler with varying staple widths along different circumferences - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medical equipment. Apparatus for stapling tissue includes a head assembly, a handle actuator in communication with the head assembly, and a staple cartridge. Head assembly is operable to drive a plurality of staples in response to actuating the handle actuator. Staple cartridge is in communication with the head assembly. Staple cartridge comprises a first annular ring of apertures and a second ring of apertures. First annular ring of apertures includes apertures having a different size from the second annular ring of apertures, such that the apertures accommodate staples having different crown lengths. Staples include pledgets that are configured to provide a greater staple area.EFFECT: surgical stapler with varying staple widths along different circumferences is disclosed.4 cl, 20 dwg

Description

BACKGROUND OF THE INVENTION

In some cases, the surgeon may need to insert a surgical instrument through an opening in the patient’s body and use the instrument to correct, position, fix and / or otherwise interact with tissue in the patient’s body. For example, parts of the gastrointestinal tract may be excised and removed during some surgical procedures to remove unwanted tissue or for other reasons. After removal of the desired tissue, it becomes necessary to reconnect the remaining parts together. One such tool for performing such anastomotic procedures is a circular stapling instrument, which is inserted through an opening in the patient's body.

Examples of circular surgical stapling instruments are described in US Pat. No. 5,205,459, entitled "Surgical Stapling Instrument for Applying an Anastomosis", issued April 27, 1993; US Pat. No. 5,271,544, entitled "Surgical Stapling Instrument for Applying an Anastomosis", issued December 21, 1993; in US patent No. 5275322, entitled "Surgical stapling instrument for applying anastomosis", issued January 4, 1994; US Pat. No. 5,285,945, entitled “Surgical Stapling Instrument for Anastomosis Application,” issued February 15, 1994; US Pat. No. 5,292,053, entitled "Surgical Stapling Instrument for Applying an Anastomosis," issued March 8, 1994; US Pat. No. 5,333,773, entitled "Surgical Stapling Instrument for Applying an Anastomosis," issued August 2, 1994; US Pat. No. 5,350,014, entitled "Surgical Stapling Instrument for Applying an Anastomosis", issued September 27, 1994; and US Pat. No. 5,533,661, entitled "Surgical Stapling Instrument for Applying an Anastomosis," issued July 9, 1996. A description of each of the aforementioned US patents is incorporated herein by reference. Some of these tools allow you to pinch tissue layers, dissect the clamped tissue layers and stitch the tissue layers with brackets to essentially fasten the separated tissue layers near the divided ends of the tissue layers, thereby connecting the two separated ends of the anatomical lumen.

Only as a further example, other surgical stapling instruments are described in US Pat. No. 4,808,523, entitled "Configuration of Depressions in Stapling Instruments for Internal Organs", issued February 21, 1989; US Pat. No. 5,415,334, entitled “Surgical Stapling Instrument and Cassette with Brackets,” issued May 16, 1995; US Pat. No. 5,465,895, entitled "Surgical Stapling Instrument", issued November 14, 1995; US Pat. No. 5,597,107, entitled "Surgical Stapling Instrument", issued January 28, 1997; US Pat. No. 5,632,432, entitled "Surgical Instrument", issued May 27, 1997; US Patent No. 5,673,840, entitled "Surgical Instrument", issued October 7, 1997; in US patent No. 5704534, entitled "Swivel Assembly for surgical instruments", issued January 6, 1998; US Patent No. 5814055, entitled "Surgical Clamping Device", issued September 29, 1998; in US patent No. 6978921, entitled "Surgical stapling tool with a trigger mechanism with an E-shaped traction", issued December 27, 2005; in US patent No. 7000818, entitled "Surgical stapling instrument having separate and different from each other closing and trigger systems", issued February 21, 2006; in US patent No. 7143923, entitled "Surgical stapling instrument having a trigger lock open stop element", issued December 5, 2006; US Pat. No. 7,303,108, entitled “Surgical Stapling Instrument Including the Multiple Descent Mechanism and Flexible Rail”, issued December 4, 2007; US Pat. No. 7,367,485, entitled "Surgical Stapling Instrument Including a Rotary Drive Multiple Descent Mechanism", issued May 6, 2008; US Pat. No. 7,380,695, entitled "Surgical Stapling Instrument having a Separate Locking Mechanism to Prevent Activation," issued June 3, 2008; US Pat. No. 7,380,696, entitled “Hinged Surgical Stapler with a Two-Part E-Link Trigger,” issued June 3, 2008; US Pat. No. 7,404,508, entitled "Surgical Stapling and Cutting Instrument", issued July 29, 2008; US Pat. No. 7,434,715, entitled “Surgical Stapling Tool with Multiple Descent Mechanism with Opening Lock”, issued October 14, 2008; and US Pat. No. 7,721,930, entitled "Disposable Adhesive Cassette for Use with a Stapler," issued May 25, 2010. A description of each of the aforementioned US patents is incorporated herein by reference. Although the aforementioned surgical stapling instruments have been described in connection with their use in endoscopic procedures, it should be understood that such surgical stapling instruments can also be used in open surgical procedures and / or other non-endoscopic procedures.

Until various types of surgical stapling instruments and related components were manufactured and used, it is believed that no one before the inventor (s) made or used the invention described in the attached claims.

BRIEF DESCRIPTION OF THE DRAWINGS

Although the specification ends with formulas that partially explain and clearly state the technology, it is believed that this technology will become clearer from the following description of specific examples in conjunction with the accompanying drawings, in which the same symbols identify the same elements.

In FIG. 1 is a side elevational view of an example of a circular surgical stapling instrument.

In FIG. 2A is an enlarged longitudinal sectional view of an example of a head assembly of the tool stapler of FIG. 1, which shows an example of a stop in the open position.

In FIG. 2B is an enlarged longitudinal sectional view of the staple head assembly of the tool of FIG. 2A, where the stop is shown in the closed state;

In FIG. 2C is an enlarged longitudinal sectional view of the staple head assembly of the tool of FIG. 2A, an example of a lever for supplying brackets and a blade in the actuation position is shown.

In FIG. 3 is an enlarged partial cross-sectional view of an example of a bracket formed about an abutment.

In FIG. 4A is an enlarged side elevational view of an example of the handle assembly of the surgical instrument drive of FIG. 1 with a removed part of the housing, which shows the trigger in the inactive position and the locking element in the locked position.

In FIG. 4B is an enlarged side elevational view of the drive handle assembly shown in FIG. 4A, where the trigger is shown in the triggered position and the locking device is in the unlocked position.

In FIG. 5 is an enlarged partial perspective view of an example of an indicator assembly of the surgical instrument of FIG. 1, where the indicator window and the indicator lever are shown.

In FIG. 6 is a schematic representation of the indicator window shown in FIG. 5, which shows an example of an indicator bar and presenting examples of corresponding brackets.

In FIG. 7 is an enlarged partial perspective view of an example cassette with brackets for use with the staple head assembly of FIG. 2A.

In FIG. 8 is a side elevational view of an example of a large bracket for use with the cassette with brackets shown in FIG. 7.

In FIG. 9 is a side elevational view of an example of a middle bracket for use with the cassette with brackets shown in FIG. 7.

In FIG. 10 is a side elevational view of an example of a small bracket for use with the cassette with brackets shown in FIG. 7.

In FIG. 11 is an enlarged top view of the cassette with brackets shown in FIG. 7, with large brackets, middle brackets and small brackets charged to the cassette.

In FIG. 12 is an enlarged partial perspective view of an example of a brace support member.

In FIG. 13 is a side elevational view of an example of an external bracket equipped with a brace support member shown in FIG. 12.

In FIG. 14 is a side elevational view of an example of a middle bracket equipped with a support element of the middle bracket.

In FIG. 15 is a side elevational view of an example of an internal bracket equipped with a support element of a small bracket.

In FIG. 16 is an enlarged top view of an example of a cassette with brackets charged with large, medium, and small brackets equipped with a bracket support element.

In FIG. 17 is an enlarged plan view of an alternative example of a brace support member with flat ridges arranged longitudinally.

In FIG. 18 is an enlarged plan view of an alternative example of a brace support member with planar projections laterally.

In FIG. 19 is an enlarged top view of an alternative example of a brace support member with flat ridges arranged longitudinally and transversely.

In FIG. 20 is a perspective view of a brace support member shown in FIG. 19, in an example of a cassette with brackets.

The drawings are not intended to be limited in any way, and it is contemplated that various embodiments of the technology may be implemented in various other ways, not necessarily shown in the drawings. The accompanying drawings, which form part of the specification and are included in it, illustrate several aspects of this technology and together with the description serve to explain the principles of the technology, it should be understood that this technology is not limited to the specific design options given.

DETAILED DESCRIPTION OF THE INVENTION

The following description of some examples of this technology should not be used to limit its scope. Other examples, features, aspects, options and advantages of the technology will become apparent to specialists in this field from the following description, which, by way of illustration, is one of the best methods provided for carrying out the technology. Once implemented, the technology described in this document may provide other various and obvious aspects without deviating from the technology. Accordingly, the drawings and descriptions are to be regarded as illustrative and non-limiting.

I. Overview of examples of circular surgical stapling instrument

In FIG. Figures 1-6 show an example of a circular surgical stapling instrument (10) having a staple head assembly (20), a main shaft assembly (60) and a drive handle assembly (70), each of which will be described in more detail below. The node (60) of the main rod runs in the distal direction from the node (70) of the drive handle, and the node (20) of the stapling head is connected to the distal end of the node (60) of the main rod. Briefly, the actuator handle assembly (70) is configured to actuate a lever (24) to feed the brackets of the staple head assembly (20) to eject a plurality of brackets (66) from the staple head assembly (20). The brackets (66) are bent to form closed brackets with a stop (40), which is attached to the distal end of the tool (10). Accordingly, the fabric (2) shown in FIG. 2A – 2C, can be stitched with brackets using the tool (10).

In the present example, tool (10) comprises a crosslinking system and a trigger system. The stapling system contains a trocar (38), a trocar drive (39) and a rotary knob (98). The stop (40) can be connected to the distal end of the trocar (38). The rotary handle (98) is capable of translational movement of the trocar (38) in the longitudinal direction relative to the staple head assembly (20), thereby moving the stop (40) when the stop (40) is connected to the trocar (38) to compress the tissue between the stop (40) and the assembly (20) of the staple head. The trigger system comprises a trigger (74), a trigger trigger assembly (84), a lever actuator (64) and a lever (24) for supplying brackets. The lever (24) for supplying the brackets includes a cutting element (36) configured to dissect the tissue when the lever (24) for supplying the brackets is driven in the longitudinal direction. In addition, the brackets (66) are placed distally with respect to the plurality of ejecting brackets of the elements (30) of the lever (24) for feeding the brackets, so that the lever (24) for feeding the brackets pushes the brackets (66) also distally when the lever (24) for feeding brackets set in motion in the longitudinal direction. Thus, when the trigger (74) is actuated and the trigger trigger assembly (84) actuates the lever (24) for feeding the brackets by the ejector drive (64), the cutting element (36) and the elements (30) essentially simultaneously dissecting the tissue (2) and pushing the brackets (66) in the distal direction with respect to the node (20) of the stapling head into the fabric. The components and functionality of the crosslinking system and the trigger system will be described in more detail in this part of the document.

A. Example of emphasis

As shown in FIG. 1–2C, the stop (40) is made with the possibility of selective connection with the tool (10) to provide a surface on which the brackets (66) can be bent to flush the material contained between the staple head assembly (20) and the stop (40). The emphasis (40) in the present example can selectively attach to a trocar or a pointed rod (38), which runs in the distal direction relative to the node (20) of the stapling head. As shown in FIG. 2A – 2C, the stop (40) is made with the possibility of selective connection by connecting the proximal main shaft (42) of the stop (40) with the distal tip of the trocar (38). The stop (40) comprises a generally round stop head (48) and a proximal main shaft (42) extending in the proximal direction from the stop head (48). In the illustrated example, the proximal main shaft (42) contains a tubular element (44) having elastically biased retaining clips (46) for selectively attaching the stop (40) to the trocar (38), although this example is provided solely as an option, and it should be understood that other holding elements can be used to attach the stop (40) to the trocar (38). For example, to attach the stop (40) to the trocar (38), C-clips, clips, threads, pins, adhesives, etc. can be used. In addition, while the abutment (40) is described as selectively attaching to the trocar (38), in some versions the proximal main shaft (42) may include a one-sided attachment member so that the abutment (40) cannot be removed from trocar (38) after attaching the stop (40). By way of example only, one-sided structural elements include spikes, one-way latches, collets, clamps, flat protrusions, rims, etc. Of course, people with average skill in the art will understand other configurations for attaching the stop (40) to the trocar (38), taking into account the ideas presented in this document. For example, in an alternative embodiment, the trocar (38) may be a hollow main shaft and the proximal main shaft (42) may comprise a cone-shaped rod inserted into the hollow main shaft.

The stop head (48) in the present example comprises a plurality of bracket-forming recesses (52) formed in the proximal front surface (50) of the stop head (48). Accordingly, when the stop (40) is in the closed position and the brackets (66) are pushed from the staple head assembly (20) into the recesses to form the brackets (52), as shown in FIG. 2C, the legs (68) of the brackets (66) are bent to form finished brackets. It should be understood that the forming brackets of the recess (52) are presented only as an option and can be excluded in some versions.

While the emphasis (40) is a separate component, it should be understood that the emphasis (40) can be inserted and attached to a piece of fabric (2) before attaching the stitching head to the assembly (20). An abutment (40) provided solely as an example can be inserted into and attached to the first tubular portion of the fabric (2), while the tool (10) is inserted into and attached to the second tubular portion of the fabric (2). For example, the first tubular part of the fabric (2) can be sewn to the part of the stop (40) or around it, and the second tubular part of the fabric (2) can be sewn to the trocar (38) or around it.

As shown in FIG. 2A, then the stop (40) is connected to the trocar (38). The trocar (38) in the present example is shown in the distal, most advanced position. Such an extended position of the trocar (38) can provide a large area to which tissue (2) can attach before the stop (40) is attached. In addition, the extended position of the trocar (38) can also provide easier attachment of the stop (40) to the trocar (38). The trocar (38) further includes a tapering distal tip. Such a tip can puncture the tissue and / or facilitate the insertion of the stop (40) onto the trocar (38), although the tapering distal tip is presented exclusively as an option. For example, in other embodiments, the trocar (38) may have a blunt tip. In addition or in an alternative embodiment, the trocar (38) may include a part with a magnet (not shown) that can attract the stop (40) in the direction of the trocar (38). Of course, people with average skill in the art will understand other configurations and designs for the stop (40) and trocar (38), taking into account the ideas presented in this document.

When the stop (40) is attached to the trocar (38), the distance between the proximal surface of the stop (40) and the distal surface of the knotting head assembly (20) forms a gap length d. In this example, the trocar (38) can translationally move longitudinally relative to the staple head assembly (20) using the adjustment knob (98) located at the proximal end of the drive handle assembly (70), as will be described in more detail below. Thus, when the stop (40) is attached to the trocar (38), the rotation of the adjusting knob (98) increases or decreases the length of the gap d by moving the stop (40) relative to the stitching head assembly (20). For example, as sequentially shown in FIG. 2A – 2B, an abutment (40) is shown proximally driven relative to the drive handle assembly (70) from the initial open position to the closed position, thereby reducing the clearance length d and the distance between the two parts of the fabric to be connected (2). As soon as the gap length d falls within the predefined range, the knotting head assembly (20) can be brought into the operating position, as shown in FIG. 2C, for flashing and dissecting the tissue (2) between the stop (40) and the knot head unit (20). The unit (20) of the stitching head is made with the possibility of flashing and cutting the fabric (2) by the user by turning the trigger (74) of the unit (70) of the drive handle, as will be described in more detail below.

As noted above, the gap length d corresponds to the distance between the stop (40) and the knotting unit assembly (20). When the tool (10) is inserted into the patient’s body, it is not always easy to see the gap length d. Accordingly, a movable indicator rod (110) shown in FIG. 5–6, which is visible through the indicator window (120), located opposite the trigger (74). The indicator rod (110) is movable in response to the rotation of the adjustment knob (98) so that the position of the indicator rod (110) reflects the gap length d. As shown in FIG. 6, the indicator window (120) further comprises a scale (130) that shows that the stop clearance is within the desired operating range (for example, a green region, or a “green zone”), as well as a corresponding representation of the bracket compression at each end of the scale (130). By way of example only, as shown in FIG. 6, the first bracket image (132) shows the height of the large bracket, while the second bracket image (134) shows the height of the small bracket. Thus, the user can see the position of the attached stop (40) relative to the node (20) of the stapling head using the rod (110) of the indicator and the scale (130). The user can then adjust the position of the stop (40) using the adjustment knob (98) accordingly.

As shown in FIG. 2A – 2C, the user sews part of the fabric (2) around the tubular element (44) so that the stop head (48) is placed inside the stitched part of the fabric (2). When the fabric (2) is attached to the stop (40), the supporting clamps (46) and part of the tubular element (44) protrude from the fabric (2) so that the user can attach the stop (40) to the trocar (38). When the fabric (2) is attached to the trocar (38) and / or another part of the staple head assembly (20), the user attaches the stop (40) to the trocar (38) and drives the stop (40) in the proximal direction with respect to the node ( 20) a stapling head, reducing the gap length d. As soon as the tool (10) is within the operating range, the user sews together the ends of the fabric (2), thereby forming a substantially continuous tubular part of the fabric (2).

The emphasis (40) may be further constructed at least in accordance with some of the ideas set forth in US Pat. No. 5,205,459; U.S. Patent No. 5,271,544; U.S. Patent No. 5,275,322; U.S. Patent No. 5,285,945; in US patent No. 5292053; U.S. Patent No. 5,333,773; U.S. Patent No. 5,350,014; in US patent No. 5533661, the contents of which are incorporated herein by reference, and / or in accordance with other configurations, as is well understood by specialists in this field of technology, taking into account the ideas set forth in this document.

B. An Example of a Staple Head Assembly

The stitching unit assembly (20) in the present example is attached to the distal end of the main shaft assembly (60) and comprises a tubular casing (22) containing a sliding lever (24) for feeding brackets and a plurality of brackets (66) contained in the recesses (32) for brackets. The brackets (66) and recesses (32) for the brackets are arranged in the form of a circular structure around the tubular casing (22). In the present example, the brackets (66) and the recesses (32) for the brackets are arranged in the form of a pair of concentric circular rows of brackets (66) and the recesses (32) for the brackets. The lever (24) for supplying the brackets is configured to be driven in the longitudinal direction inside the tubular casing (22) in response to the rotation of the trigger (74) of the drive handle assembly (70). As shown in FIG. 2A – 2C, the lever (24) for supplying the brackets comprises an expanding cylindrical element having an opening (26) for the trocar, a central recess (28) and a plurality of elements (30) arranged circumferentially around the central recess (28) and extending distally relative to the assembly (60) main shaft. Each element (30) is configured to enter into contact and engage with a corresponding bracket (66) from a plurality of brackets (66) in the recesses (32) for the brackets. Thus, when the lever (24) for supplying the brackets is driven in the distal direction relative to the node (70) of the drive handle, each element (30) pushes the corresponding bracket (66) from the recess (32) for the bracket through the hole (34) for the bracket formed at the distal end of the tubular casing (22). Since each element (30) extends from the lever (24) for feeding the brackets, a plurality of brackets (66) are ejected from the knotting head assembly (20) at substantially the same time. When the stop (40) is in the closed position, the brackets (66) are pushed into the forming brackets of the recess (52) to bend the legs (68) of the brackets (66), thereby flashing the material located between the stop (40) and the stitching unit (20) heads. In FIG. Figure 3 shows one example of a bracket (66) pushed by an element (30) into a recess (32) to form the stop brackets (40) to bend the legs (68).

The lever (24) for supplying the brackets further includes a cylindrical cutting element (36), which is located coaxially with the hole (26) of the trocar and is inserted from the recesses (32) for the brackets. In the present example, a cylindrical cutting element (36) is located in the central recess (28) for translational movement in the distal direction by the lever (24) for feeding the brackets. When the abutment (40) is attached to the trocar (38) as described above, the abutment head (48) provides a surface in contact with which the cylindrical cutting element (36) cuts the material contained between the abutment (40) and the stitching head assembly (20) . In some embodiments, the stop head (48) may comprise a cavity (not shown) for the cylindrical cutting element (36) to facilitate excision of the material (for example, by providing a joint cutting edge). In addition or in an alternative manner, the stop head (48) may include one or more opposing cylindrical knives (not shown) offset from the cylindrical cutting element (36), so that it is possible to perform dissection of the type performed by the scissors. Other configurations will be readily apparent to those skilled in the art, taking into account the ideas set forth herein. The stitching unit assembly (20) is thus configured to both stitch and excise the tissue (2) substantially simultaneously in response to driving the drive handle assembly (70).

Of course, the stitching unit assembly (20) can be further constructed at least in accordance with some of the ideas set forth in US Pat. No. 5,205,459; U.S. Patent No. 5,271,544; U.S. Patent No. 5,275,322; U.S. Patent No. 5,285,945; in US patent No. 5292053; U.S. Patent No. 5,333,773; U.S. Patent No. 5,350,014; in US patent No. 5533661, the contents of which are incorporated herein by reference, and / or in accordance with other configurations, as is well understood by specialists in this field of technology, taking into account the ideas set forth in this document.

As noted earlier, the lever (24) for supplying brackets has an opening (26) for the trocar. The hole (26) for the trocar is made with the possibility of sliding the trocar (38) in the longitudinal direction relative to the node (20) of the stapling head and / or node (60) of the main rod. As shown in FIG. 2A – 2C, the trocar (38) is connected to the trocar drive (39) so that the trocar (38) can be driven in the longitudinal direction by rotating the rotary knob (98), as will be described in more detail below with respect to the assembly (70) drive handles. In the present example, the trocar drive (39) contains an elongated, relatively rigid main shaft attached to the trocar (38), although this example is provided solely as an option. In some versions, the actuator (39) may contain material that is rigid in the longitudinal direction, while allowing bending in the lateral directions, so that parts of the tool (10) can be selectively bent or bent during use or the tool (10) may include a node (60) the main rod with a predefined bend. By way of example only, the material is nitinol. When the stop (40) is attached to the trocar (38), the trocar (38) and the stop (40) can be progressively moved by means of a drive (39) to adjust the length of the gap d between the stop (40) and the knot head assembly (20). Of course, people with average skill in the art will understand other drive configurations (39) for driving the trocar (38) in the longitudinal direction, taking into account the ideas presented in this document.

C. Example of the main rod assembly

The stitching unit assembly (20) and the trocar (38) are located at the distal end of the main shaft assembly (60), as shown in FIG. 2A – 2C. The node (60) of the main rod in the present example contains an outer tubular element (62) and a drive (64) of the ejector. The outer tubular element (62) is attached to the tubular casing (22) of the stitching head assembly (20) and to the housing (72) of the drive handle assembly (70), thereby providing mechanical means for actuating the components contained therein. The proximal end of the ejector drive (64) is connected to the trigger assembly (84) of the trigger assembly of the drive handle (70) described below. The distal end of the lever actuator (64) is connected to the lever (24) for supplying the brackets, so that the rotation of the trigger (74) brings the lever (24) for supplying the brackets in the longitudinal direction. As shown in FIG. 2A – 2C, the ejector drive (64) comprises a tubular member having an open longitudinal axis, so that the drive (39) connected to the trocar (38) can drive longitudinally inside and relative to the ejector drive (64). Of course, it should be understood that other components can be placed in the drive (64) of the ejector, as it will be obvious to persons with average skill in the art, taking into account the ideas presented in this document.

The node (60) of the main rod can be additionally designed at least in accordance with some of the ideas set forth in US patent No. 5205459; U.S. Patent No. 5,271,544; U.S. Patent No. 5,275,322; U.S. Patent No. 5,285,945; in US patent No. 5292053; U.S. Patent No. 5,333,773; U.S. Patent No. 5,350,014; in US patent No. 5533661, the contents of which are incorporated herein by reference, and / or in accordance with other configurations, as is well understood by specialists in this field of technology, taking into account the ideas set forth in this document.

D. Example of drive handle assembly

As shown in FIG. 4A – 5, the actuator handle assembly (70) comprises a housing (72), a trigger (74), a blocking element (82), a trigger trigger assembly (84), and a trocar for actuating the assembly (90). The trigger (74) of this example is rotatably mounted on the housing (72) and connected to the trigger trigger assembly (84) so that the trigger (74) is rotated from an inactive position (shown in FIG. 4A) to the trigger position (shown in FIG. 4B) activates the lever actuator (64) described above. A spring (78) is attached to the housing (72) and the trigger (74) to bias the trigger (74) towards the idle position. The locking structural element (82) is a pivoting element that is attached to the housing (72). In the first, locked position, the locking element (82) is rotated up and away from the housing (72) so that the locking element (82) is engaged with the trigger (74) and mechanically prevents the user from activating the trigger (74). In the second, unlocked position, as shown in FIG. 1 and 4B, the locking element (82) is rotated downward so that the trigger (74) can be actuated by the user. Thus, with the locking structural element (82) in the second position, the trigger (74) can engage with the trigger assembly (84) to trigger the apparatus (10).

As shown in FIG. 4A – 4B, the trigger trigger assembly (84) in the present example includes a slide carriage (86) that is slidably engaged at the proximal end of the ejector drive (64). The carriage (86) contains a set of flat protrusions (88) at the proximal end of the carriage (86) to hold and engage with a pair of shoulders (76) of the trigger, continuing from the trigger (74). Thus, when the trigger (74) is rotated, the carriage (86) is driven in the longitudinal direction and communicates the movement in the longitudinal direction to the actuator (64) of the ejector. In the example shown, the carriage (86) is rigidly attached to the proximal end of the ejector drive (64), although this example is provided solely as an option. Moreover, in one alternative embodiment, given solely as an example, the carriage (86) can simply abut against the ejector drive (64), while the distal spring (not shown) biases the ejector drive (64) in the proximal direction relative to the assembly ( 70) drive handles.

The trigger trigger assembly (84) may be further constructed at least in accordance with some of the ideas set forth in documents such as US Pat. No. 5,205,459; US patent No. 5271544; US patent No. 5275322; U.S. Patent No. 5,285,945; U.S. Patent No. 5,292,053; U.S. Patent No. 5,333,777; US patent No. 5350104; US patent No. 5533661, the contents of which are incorporated herein by reference, and / or in accordance with other configurations, as is well understood by specialists in this field of technology, taking into account the ideas set forth in this document.

The housing (72) also accommodates a trocar actuating unit (90) configured to drive the trocar (38) in the longitudinal direction in response to the rotation of the adjustment knob (98). As best shown in FIG. 4A – 5, the trocar activation unit (90) of the present example comprises an adjusting knob (98), a threaded shank (94), and a sleeve (92). The threaded shank (94) in the present example is located at the distal end of the trocar drive (39), although it should be understood that the threaded shank (94) and trocar drive (39) may alternatively be separate components that engage to communicate movement in the longitudinal direction. The adjustment knob (98) is rotatably supported by the proximal end of the housing (72) and is configured to rotate the sleeve (92), which is engaged with the threaded shank (94) through an internal protrusion (not shown). The threaded shank (94) in the present example contains a continuous groove (96) formed on the outer surface of the threaded shank (94). Thus, when turning the adjusting knob (98), the inner protrusion moves in the groove (96) and the threaded shank (94) is driven in the longitudinal direction relative to the sleeve (92). Since the threaded shank (94) is located at the distal end of the trocar drive (39), turning the adjusting knob (98) in the first direction moves the trocar drive (39) in the distal direction relative to the drive handle assembly (70). Accordingly, the length of the gap d between the stop (40) and the node (20) of the stapling head increases. When the adjustment knob (98) is rotated in the opposite direction, the trocar drive (39) is driven in the proximal direction relative to the drive handle assembly (70) to reduce the gap length d between the stop (40) and the stapling head assembly (20). Thus, the trocar actuating unit (90) is configured to actuate the trocar (38) in response to the rotation of the adjustment knob (98). Of course, those with average skill in the art will understand other configurations of the trocar actuator assembly (90), taking into account the ideas set forth herein.

The recess (96) in the present example contains many different parts (96A, 96B, 96C) that have different thread pitch or number of grooves per unit axial distance. The present trough (96) is divided into the distal part (96A), the middle part (96B) and the proximal part (96C). As shown in FIG. 5, the distal portion (96A) contains a small pitch or a large number of grooves over the short axial distance of the threaded shank (94), so that a large number of rotations of the adjusting knob (98) are required to travel a short axial distance. The middle portion (96B) contains a portion with a relatively larger pitch or fewer grooves in the axial section, so a relatively small number of turns are required to cover a long axial distance. Thus, the clearance length d can be quickly reduced by a relatively small number of turns of the adjusting knob (98). The proximal part (96C) of the present example is essentially similar to the distal part (96A) and contains a small thread pitch or a large number of grooves on a small axial segment of the threaded shank (94), so that a large number of rotations are required to travel a short axial distance. The proximal portion (96C) in the present example is located inside the sleeve (92) when the stop (40) is substantially adjacent to the staple head assembly (20) so that the indicator rod (110) moves in the indicator window (120) on a scale (130) ) to indicate that the stop gap is within the desired operating range, as will be described in more detail below. Thus, when the protrusion is within the proximal part (96C) of the trough (96), each turn of the adjusting knob (98) can reduce the clearance length d by a small amount, which ensures fine tuning.

The trocar actuator assembly (90) may be further constructed in accordance with at least some of the ideas set forth in documents such as US Pat. No. 5,205,459; US patent No. 5271544; US patent No. 5275322; U.S. Patent No. 5,285,945; U.S. Patent No. 5,292,053; U.S. Patent No. 5,333,777; US patent No. 5350104; US patent No. 5533661, the contents of which are incorporated herein by reference, and / or in accordance with other configurations, as is well understood by specialists in this field of technology, taking into account the ideas set forth in this document.

In the example shown in FIG. 4A – 4B, the U-shaped clamp (100) is attached to the intermediate part of the trocar drive (39) placed distally relative to the threaded shank (94). The U-shaped clamp (100) engages with a part of the housing (72) in order to essentially prevent the trocar drive (39) from rotating around its axis while rotating the adjustment knob (98). The U-shaped clamp (100) further includes an elongated groove (102) on each of its opposite sides for receiving a fastening member, such as a screw, bolt, pin, clamp, etc., for selectively adjusting the longitudinal position of the elongated groove ( 102) U-shaped clamp (100) relative to the actuator (39) of the trocar with the aim of calibrating the rod (110) of the indicator relative to the scale (130).

As shown in FIG. 5, the actuator handle assembly (70) further includes an indicator bracket (140) configured to engage and rotate the indicator (104). The indicator bracket (140) in the present example can slide relative to the housing (72) along a pair of grooves formed in the housing (72). The indicator bracket (140) contains a rectangular plate (144), a shoulder (146) of the indicator and an angular flange (142). An angular flange (142) is formed at the proximal end of the rectangular plate (144) and includes an opening (not shown) for sliding installation on the trocar actuator (39) and / or threaded shank (94). A spiral spring (150) is placed between the flange (142) and the stop (152) to bias the flange (142) against the U-shaped clamp (100). Thus, when the U-shaped clamp (100) is driven in the distal direction by the actuator (39) of the trocar and / or the threaded shank (94), the coil spring (150) causes the indicator bracket (140) to translate in the distal direction with U -shaped clamp (100). In addition, the U-shaped clamp (100) causes the indicator bracket (140) to move in the proximal direction relative to the stop (152) when the actuator (39) of the trocar and / or threaded shank (94) move progressively in the proximal direction, thereby compressing the spiral spring (150). Of course, it should be understood that in some embodiments, the indicator bracket (140) can be rigidly attached to the actuator (39) of the trocar and / or threaded shank (94).

In the present example, a part of the locking structural element (82) abuts against the surface (141) of the indicator bracket (140) when the indicator bracket (140) is in a longitudinal position, which indicates that the stop gap is outside the desired operating range (for example, in the green area, or in the "green zone"). When the emphasis interval is within the desired operating range (for example, in the green area, or in the “green zone”), the shape of the indicator bracket (140) narrows and opens a pair of spaces (145) on each side of the indicator arm (146), which allows rotate the locking structural element (82), thereby releasing the trigger (74). Thus, by using the locking structural member (82) and the indicator bracket (140), it is possible to substantially prevent the user from releasing and using the trigger (74) until the stop (40) is within a predetermined operating range. Of course, it should be understood that the locking structural element (82) can be completely eliminated in some cases.

The user can obtain information about this operating range by visually observing the position of the rod (110) of the indicator (104) on the scale (130) described briefly above. At the distal end of the indicator bracket (140), there is a distally protruding shoulder (146) of the indicator, which ends with a finger protruding to the side (148) to control the movement of the indicator (104). The indicator bracket (146) and the finger (148), as best shown in FIG. 5 are configured to engage the tab (106) of the indicator (104) so that the indicator (104) rotates when the indicator bracket (140) is activated longitudinally. In the present example, the indicator (104) is rotatably connected to the housing (72) at the first end of the indicator (104), although this example is provided solely as an option, and other turning points for the indicator (104) will be fully understood by specialists in this field of technology subject to the ideas presented in this document. The indicator rod (110) is located at the second end of the indicator (104), so that the indicator rod (110) is moved in response to the actuation of the indicator bracket (140). Accordingly, as described above, the indicator rod (110) is displayed through the indicator window (120) against the background of the scale (130) (as shown in Fig. 6), displaying the gap length d between the stop (40) and the unit (20) of the stapling head.

Of course, the indicator bracket (140), the indicator (104) and / or the handle assembly (70) of the drive handle can be further constructed at least in accordance with some of the ideas set forth in US Pat. No. 5,205,459; U.S. Patent No. 5,271,544; U.S. Patent No. 5,275,322; U.S. Patent No. 5,285,945; in US patent No. 5292053; U.S. Patent No. 5,333,773; U.S. Patent No. 5,350,014; in US patent No. 5533661, the contents of which are incorporated herein by reference, and / or in accordance with other configurations, as is well understood by specialists in this field of technology, taking into account the ideas set forth in this document.

II. An example of a cassette with brackets

During operation of the tool (10), the cartridge (200) with brackets can be used to hold the brackets (66) in readiness for launch in a variety of concentrically arranged circles. In some embodiments, each circle with brackets (66) in the cassette (200) with brackets may contain an equal number of brackets (66), even if these circles have different radii due to the different total width of each bracket in a circle with brackets. It should be understood that due to the different widths of the brackets (66), the inner of concentric circles with brackets (66) can be more densely charged with brackets than the outer circle. It is also worth considering that providing an equal number of brackets (66) in each concentric circle can improve hemostasis when stitching tissue brackets (66). Also, other desired effects may occur as a result. In FIG. 7 shows an example of a cartridge (200) with brackets suitable for use with a tool (10), in which three circles with brackets contain the same number of brackets in each circle. In general, the cassette (200) with brackets is able to contain many brackets (250, 252, 254) (as shown in Figs. 8–10), which have different shapes and sizes, as will be described in detail below. In some embodiments, the brackets (250, 252, 254) may be located in the cassette (200) with brackets along with other auxiliary means and / or components that can be made to start together with the brackets (250), as will be described in detail below . Undoubtedly, it should be understood that the brackets (250, 252, 254) can be charged into the cassette (200) with brackets separately, without any additional components.

The cassette (200) with brackets contains an upper ring (204) and a lower case (202). In this example, the cassette (200) with brackets has the shape of an elongated ring, but it should be understood that the cassette (200) with brackets can be of any suitable shape, which will be obvious to people with average skill in the art, taking into account the ideas presented in this document. The upper ring (204) contains many holes (210) for the brackets, which are located around the circumference of the upper ring (204). The holes (210) for the brackets are in the form of an elongated hexagon with rounded ends, as shown in FIG. 7 and further in FIG. 11. It should be understood that the holes (210) for the brackets can be of any suitable shape, such as an elongated rectangle, ellipse, circle, square, slot shape, or any other shape suitable for receiving one or more brackets, which will be obvious to persons having average skill in the art, taking into account the ideas presented in this document.

As shown in FIG. 7 and 11, three circumferences of the holes (210) for the brackets lie along the circumference of the upper ring (204). The outer circumference (214), the middle circumference (216) and the inner circumference (218) constitute the annular rows of holes (210) for the brackets. The outer circumference (214) of the holes (210) for the brackets contains the largest holes (210) for the brackets, and as a result, it should be understood that the outer ring (214) has the smallest density or the least number of holes (210) for the brackets. The inner circle (218) contains the holes (210) of the smallest size, so that the inner circle (218) has the highest density of holes (210) for the brackets. The middle circle (216) is located between the outer circle (214) and the inner circle (218). The middle circle (216) contains holes (210) for the brackets, the size of which is the average between the sizes of the holes (210) for the brackets of the outer circle (214) and the inner circle (218). As a result, the density of the holes (210) for the brackets of the middle circle (216) is between the densities of the holes of the outer circle (214) and the inner circle (218). The outer circle (214), the middle circle (216) and the inner circle (218) are concentrically around the hole (212) located on the cassette (200) with brackets. In some versions, the number of holes (210) for the brackets of the inner circle (218) is equal to the number of holes (210) for the brackets of the middle circle (216) and the number of holes (210) for the brackets of the outer circle (214). However, it should be understood that the number of holes (210) for brackets in different circles (214, 216, 218) may vary in some versions. Additionally, the outer circle (214), the middle circle (216) and the inner circle (218) are arranged so that the holes (210) for the brackets of the middle circle (216) are located between the holes (210) for the brackets of the outer circle (214) and the inner circle (218). It should be understood that you can apply other options for the location of the outer circle (214), the middle circle (216) and the inner circle (218), as will be obvious to persons with average skill in the art, taking into account the ideas presented in this document. For example, although the middle circle (216) divides the distance between the inner circle (218) and the outer circle (214) approximately in half, it should be understood that the middle circle (216) may be closer to the inner circle (218) or to the outer circle (214) ) It should also be understood that, although the outer circle (214), the middle circle (216) and the inner circle (218) contain holes (210) for the brackets, the arrangement of which follows the shape of the circle lying on the upper ring (204), in this example, other hole arrangements (210) for the brackets may also be used. For example, the location of the holes (210) for the brackets may repeat the shape of an ellipse or square lying on the upper ring (204). Moreover, the holes (210) for the brackets can be located in any suitable way on the upper ring (204), which will be obvious to people with average skill in the art, taking into account the ideas set forth in this document.

The cassette (200) with brackets is placed in the tubular casing (22) of the knotting head assembly (20). In particular, the lower housing (202) provides a friction fit in the tubular casing (22). It should be understood that other suitable methods of connecting the cartridge (200) to the brackets and the knot (20) of the stapling head can be used, as will be apparent to those with average skill in the art, taking into account the ideas set forth herein. For example, a cassette (200) with brackets may be secured by clamping by tight fitting, screwing in, or otherwise selectively attaching the stitching head assembly (20) in any suitable manner. In the lower case (202) of the cartridge (200) with brackets, channels (206) are also provided, configured to receive additional lever elements (24) for supplying the brackets. The channels (206) communicate with the holes (210) for the brackets in such a way that additional elements of the lever (24) for supplying the brackets can be advanced through the channels (206) to push the brackets (250, 252, 254). The size of the hole (212) allows you to take a cylindrical cutting element (36), which is pushed through the hole (212) to excise the fabric in the manner described above, when the fabric is sandwiched between the node (20) of the stapling head and the stop (40).

In FIG. Figure 8 shows a large bracket (250) that can be placed in holes (210) for the brackets of the outer circumference (214). A large bracket (250) comprises a head (262) and legs (260) emanating from the head (262). As shown in the illustrated example, the legs (260) extend outward, expanding so that the legs (260) form a distance A between the legs (260), with A being wider than the head (262). Each leg (260) ends with an angled tip (264), which can help push the leg (260) of the large bracket (250) through the fabric. It should be understood that the width of the legs (260) at a distance A corresponds to the size of the holes (210) for the brackets of the outer circle (214). In some embodiments, A is slightly larger than the width of the holes (210) for the brackets of the outer circumference (214), so that a large bracket (250) is fixed in the holes (210) for the brackets with the possibility of release by means of a tight fit.

In FIG. 9 shows the middle bracket (252), which can be placed in the holes (210) for the brackets of the middle circle (216). The middle bracket (252) contains the head (268) and legs (266), emanating from the head (268). As shown in the illustrated example, the legs (266) extend outward, expanding so that the legs (266) form a distance B between the legs (266), and B is wider than the head (268). The legs (266) end at an angled tip (270), which can help push the large bracket (252) through the fabric. It should be understood that the width of the legs (266) at a distance B corresponds to the size of the holes (210) for the brackets of the middle circle (216). In some embodiments, B is slightly larger than the width of the holes (210) for the brackets of the middle circle (216), so that the middle bracket (252) is fixed in the holes (210) for the brackets with the possibility of release by means of a tight fit.

In FIG. 10 shows a small bracket (254), which can be placed in the holes (210) for the brackets of the inner circle (218). A small bracket (254) contains a head (274) and legs (272), emanating from the head (274). As shown in the illustrated example, the legs (272) extend outward, expanding so that the legs (272) form a distance C between the legs (272), and C is wider than the head (274). The legs (272) end with an angled tip (276), which can help push the small bracket (254) through the fabric. It should be understood that the width of the legs (272) at a distance C corresponds to the size of the holes (210) for the brackets of the inner circle (218). In some embodiments, C is slightly larger than the width of the holes (210) for the brackets of the inner circle (218), so that a small bracket (254) is fixed in the holes (210) for the brackets with the possibility of release by means of a tight fit.

As shown in FIG. 8–10, the large bracket (250) has a head (262) that is longer than the head (268) of the middle bracket (252) and the head (274) of the small bracket (254), and the head of the middle bracket (252) is longer than the head (274) of the small brackets (254). It should be understood that the values of the relative width of the brackets (250, 252, 254) are such that the small brackets (254) can be placed in the holes (210) for the brackets so as to provide a relatively high density of small brackets (254) around the cartridge (200) with brackets. Accordingly, the middle brackets (252) and large brackets (250) can be placed around the cassette with brackets so as to provide a lower density of the middle brackets (252) and the lowest density of the large brackets (250). As a result of the above-described gradual reduction in the length of the heads (262, 268, 274), the number of brackets (250, 252, 254) in each circle (214, 216, 218) may be the same.

Although the legs (260, 266, 272) are depicted as expanding, it should be understood that the legs (260, 266, 272) can be perpendicular to the head (262, 268, 274), located at an acute angle to the head (262, 268, 274) or at any other suitable angle with respect to the head (262, 268, 274), which will be obvious to persons with average skill in the art, taking into account the ideas presented in this document. Additionally, it should be understood that the legs (260, 266, 272) do not have to be in a straight shape. For example, the legs (260, 266, 272) may be curved, curved, or any other suitable shape that can help push the brackets (250, 252, 254) through the fabric. In addition to this, although in FIG. Figures 8–10 show brackets (250, 252, 254) with legs (260, 266, 272) having generally equal thickness, it should be understood that legs (260, 266, 272) can have different thicknesses. For example, a large bracket (250) may have legs (260) thicker or thinner than the legs (272, 266) of a small bracket (254) or a middle bracket (252). In other versions, instead of having a uniform thickness, the legs (260, 266, 272) may have a variable thickness. For example, the legs (260, 266, 272) may be thicker or thinner near the head (262, 268, 274) or near the tip (264, 270, 276) or their thickness may vary in any other suitable way, which will be obvious to persons having average skill in the art, taking into account the ideas presented in this document. Although the example describes a cassette (200) with brackets having three circles (214, 216, 218) of brackets (250, 252, 254), it should be understood that two circles or more than three circles with brackets can be used.

In FIG. Figure 11 shows the brackets (250, 252, 254) placed in the holes (210) for the brackets of the cartridge (200) for the brackets. It should be understood that the brackets (250, 252, 254) can be supplied pre-charged, but in other versions it should be understood that the brackets (250, 252, 254) can be charged into the cassette (200) with brackets at any suitable time before using the stapler tool (10).

In one example, the cassettes (200) with brackets, the cassette (200) with brackets can be charged, as shown in FIG. 11. The lower housing (202) can be inserted into the tubular casing (22). The tubular element (44) is placed through the hole (212) of the cartridge (200) with brackets. Additionally, the circular cutting element (36) is made with the possibility of translational movement through the hole (212) of the cartridge (200) with brackets. The lever (24) for feeding the brackets is located relative to the cartridge (200) with brackets so that as the lever (24) for feeding the brackets moves in the distal direction, the lever (24) for feeding the brackets moves through the channel (206), pushing the brackets (250 , 252, 254) in the distal direction. As a result, when the trigger (74) is turned, the lever (24) for feeding the brackets is driven in the longitudinal direction, pushing the brackets (250, 252, 254) distally into the fabric. The legs (260, 266, 272) of the brackets (250, 252, 254) are in contact with the recesses (52) of the stop head (48) forming the brackets, thereby bending the legs (260, 266, 272) to the corresponding heads (262, 268, 274). The circular cutting element (36) also performs translational motion to excise tissue. The circular cutting element (36) is then retracted and the lever (24) is retracted to feed the brackets. The brackets (250, 252, 254) remain in the tissue, where they provide an anastomosis between the two cavities in the patient’s body (for example, fasten the two edges of the esophagus, colon or other part of the gastrointestinal tract, etc.). It should be understood that, after the brackets sewn through the fabric, the circle of brackets formed by the outermost outer large brackets (250) can serve as a structural fastening of the anastomosis, and the circle of brackets formed by the middle brackets (252) or small brackets (254) ensures tightness anastomosis. In other words, the large bracket (250) can mainly play the role of structural hardening, and the middle bracket (252) and / or the small bracket (254) can mainly provide a seal that does not leak liquid. Brackets (250, 252, 254) can be made with the possibility of resorption in the future.

III. An example of a bracket element

It should be understood that as the brackets (250, 252, 254) are pushed into the fabric, in some examples, taking into account the thickness of the brackets (250, 252, 254), the brackets (250, 252, 254) may fall through the fabric or may not be able to hold in another way in the fabric. In FIG. 12 illustrates an example of a retaining pad or brace support member (300) that can be used to increase the area occupied by the brace head, thereby reducing the risk that the head would otherwise pass through the fabric. The support element (300) in this example comprises a housing (302) of the support element, in which a pair of holes (304) are made with the possibility of receiving legs (260, 266, 272) of brackets (250, 252, 254). The housing (302) also comprises an opening (310) of the housing extending through the housing of the bracket support member (300). It should be understood that the support element (300) brackets can be used to prevent breakthrough tissue brackets (250, 252, 254). Additionally, the bracket support element (300) may be configured to reduce the number of leak points in the region where the brackets (250, 252, 254) are inserted into the fabric, and may also be configured to absorb the separated liquid in the event of a leak. The size of the bracket support element (300) is such that the bracket support element (300) can be placed on the brackets (250, 252, 254) so that the brackets (250, 252, 254) can still be placed in the holes (210) for brackets, as shown, for example, in FIG. 11. In addition, it should be borne in mind that a different size of the bracket support element (300) can be chosen to correspond to brackets (250, 252, 254) of different sizes. The brace support element (300) can be made of any suitable material capable of preventing leakage or absorbing fluid that has leaked through the fabric around the place of use of the brace (250, 252, 254). For example, the bracket support element (300) may be made of a polymeric material or, in addition to this, or as an alternative to this, may be made of an absorbent material. Other suitable materials can be used to make the brace support element (300), as will be apparent to those with average skill in the art, taking into account the ideas presented herein.

The holes (304) are arranged to lie on a straight line with the legs (260, 266, 272) of the brackets (250, 252, 254), as shown (legs are inserted into the holes) in FIG. 13-15. The holes (304) are in the shape of a circle, however, it should be understood that the holes (304) can be of any suitable shape. For example, the holes (304) may be in the form of a square, ellipse, or any other suitable shape for receiving legs (260, 266, 272). When the legs (260, 266, 272) are inserted into the holes (304), the holes (304) have a sufficiently tight fitting shape or are placed at such intervals that the friction fit holds the body (302) on the brackets (250, 252, 254). The hole (310) of the housing is located so as to lie on one straight line with the heads (262, 268, 274) of the brackets (250, 252, 254). In this example, the opening (310) of the housing has the shape of an extended cross. In other examples, it should be understood that the opening (310) of the housing may have any suitable shape. For example, the housing opening (310) may be in the shape of a circle, square, or any suitable shape. In other examples, it should be understood that the opening (310) of the housing may be omitted.

The bracket support element (300) also includes wings (306) extending outward from the body (302). Although the wings (306) are rectangular in this example, other suitable shapes can be used. By way of example only, the wings (306) may have a rounded or triangular shape. The version of the example depicts wings (306) located on opposite sides of the opening (310) of the housing, but it should be understood that the wings (306) can be located in any suitable area around the support element (300) of the bracket. Additionally, the wings (306) can be made in such a way that more than two wings (306) can be arranged around the bracket support element (300). Other suitable options will be apparent to those with average skill in the art, taking into account the ideas presented in this document.

The bracket support element (300) further comprises a plurality of protrusions (308) located near the holes (304). The protrusions (308) are equidistant around the holes (304), but it should be understood that the protrusions (308) can be located in any suitable way around the holes (304). In some versions, protrusions (308) may be completely omitted.

In FIG. 13 illustrates a brace support member (300) mounted on a large bracket (250). In FIG. 14 shows a support element (350) of the middle bracket, which is essentially identical to the support element (300) of the bracket, but reduced in scale so that its size corresponds to the middle bracket (252). The middle bracket support member (350) may be mounted on the middle bracket (252), as shown in FIG. 14. In FIG. 15 shows a support element (352) of a small bracket, which is essentially identical to the support element (300) of the bracket, but reduced in scale so that its size corresponds to a small bracket (254). The small bracket support member (352) may be mounted on the small bracket (254), as shown in FIG. 15. It should be understood that the support elements (300, 350, 352) of the brackets can be of other sizes, not shown in the illustrated embodiment, for receiving brackets of a larger or smaller size. Additionally, in some versions, only one set of brackets (for example, large brackets (250)) is equipped with support elements (300), while other brackets (for example, brackets (252, 254)) are not equipped with them. Other suitable options for equipping only some brackets with support elements (300) will be apparent to those with average skill in the art, taking into account the ideas presented in this document.

In FIG. 16 shows an example of a cassette (400) with brackets, in the holes (410) for the brackets of which brackets are charged (250, 252, 254). It should be understood that the holes (410) for the brackets may be the same size as the holes (210) for the brackets shown in FIG. 7, but it should also be understood that the openings (410) for the brackets can have a shape that complements the brackets (250, 252, 254) equipped with support elements (300) of the bracket. Additionally, the cassette (400) with brackets can be configured in another way and used in a manner substantially identical to that described above for the cassette (200) with brackets. It should be understood that the supporting elements (300) of the brackets with brackets (250, 252, 254) can be made with the possibility of increasing the structural integrity of the anastomosis and are additionally configured to reduce the risk of leakage by reducing the number and size of potential leakage places in the anastomosis.

IV. An example of a bracket element with flat tabs

In FIG. 17 depicts an alternative bracket support element (500) having a housing (502), holes (504) and longitudinally projecting flat protrusions (506). Longitudinally located flat protrusions (506) protrude outward from the housing (502) along the longitudinal axis formed by the housing (502). The flat protrusions (506) are designed to increase the area occupied by the bracket support element (500) to further reduce the risk that the brackets (250, 252, 254) otherwise slip through the fabric without hindrance. As shown in FIG. 17, due to the presence of flat protrusions (506), the support element (500) of the bracket has an elongated area. Flat protrusions (506) can help increase the structural integrity of the anastomosis in combination with the support element (500) and brackets (250, 252, 254) and are additionally designed to reduce the risk of leakage by reducing the number and size of potential leakage points in the anastomosis.

In FIG. 18 depicts an alternative embodiment of the bracket support member (600) having a housing (602), holes (604) and transversely flat projections (606). It should be understood that the transversely flat protrusions (606) can be used to increase the area occupied by the bracket support element (600). Although the example describes a brace support element (600) with four transversely planar projections (606), it should be understood that any suitable number of planar projections (606) can be used. In FIG. 19 shows an alternative embodiment of the bracket support member (700) having a housing (702), holes (704) and a combination of flat projections (706) arranged transversely and flat projections (708) arranged longitudinally. Due to the flat protrusions (706) arranged transversely and the flat protrusions (708) arranged longitudinally, it should be understood that the area occupied by the support element (700) of the bracket will increase both in width and in length. As discussed above, flat protrusions (606) with a brace support element (600) can be used to increase the structural integrity of the anastomosis in combination with brackets (250, 252, 254) and additionally to reduce the risk of leakage by reducing the number and size of potential leak points in the anastomosis .

In FIG. 20 illustrates a brace support element (700) located in an opening (710) of the bracket cassette (750). The horizontal (706) and vertical flat protrusions (708) are arranged to be located outside the hole (710) so that the flat protrusions (706, 708) do not fall through the hole (710). The bracket support element (700) can be charged together with a bracket (not shown) passing through the holes (704). At the moment of starting the bracket, charged together with the support element (700), the brackets, the bracket and the support element (700) are released from the hole (710) of the cartridge (750) with brackets and engage with the fabric.

It should be understood that any one or more of the ideas, expressions, embodiments, examples, etc. described herein may be combined with one or more other ideas, expressions, embodiments, examples, etc. described in this document. Therefore, the above ideas, expressions, embodiments, examples, etc., should not be considered. separately from each other. Various suitable ways in which the ideas contained in them can be combined will be apparent to those skilled in the art, given these teachings. Such modifications and changes are intended to be included in the scope of the claims.

It should be borne in mind that any patent, publication or other materials, in whole or in part, incorporated herein by reference, are included here only to the extent that does not contradict the existing definitions, statements or other materials, disclosures set forth in this description. In this regard, the description presented in this document, to the necessary extent, has an advantage over any information contrary to the provisions of this document, which could be included in the specified document by reference. Any material or part thereof, incorporated herein by reference and contrary to the definitions, provisions or other information provided herein, is included in this document to the extent that there is no conflict between the material incorporated by reference and this document.

Versions of the devices described above can be used in traditional types of medical treatment and procedures performed by a medical specialist, as well as in robotic types of medical treatment and procedures. By way of example only, the various ideas set forth in this application can be easily used in any robotic surgical system, for example, the DAVINCI ™ system created by Intuitive Surgical, Inc., Sunnyvale, California. Similarly, those with average knowledge in the art can understand that the various ideas set forth in this document can be combined with the various ideas set forth in US Pat. No. 6,783,524 entitled “Robotic Surgical Instrument with Ultrasonic Cauterization and Cutting Instrument” from August 31, 2004, the description of which is incorporated herein by reference.

The versions described above may be disposed of after a single use, or may be made available for repeated use. Versions in either one or both cases can be prepared for reuse after at least one use. Preparing the device for reuse may include any combination of the steps of disassembling the device, subsequent cleaning or replacement of parts, and subsequent assembly. In particular, some versions of the device can be disassembled and any number of specific elements or parts of the device can be selectively replaced or removed in any combination. After cleaning and / or replacing specific parts, some versions of the device can be reassembled for later use either in the department preparing for reuse, or by the user immediately prior to the procedure. Those skilled in the art will understand that preparing a device for reuse may include various methods for disassembling, cleaning / replacing, and reassembling. The use of such methods and the resulting reconditioned device are included in the scope of this application.

By way of example only, the versions described herein can be sterilized before and / or after the procedure. In one sterilization technique, the device is placed in a closed and sealed container, such as a plastic bag or Tyvek bag (TYVEK). The container and device can then be placed in a field of radiation that can penetrate into the container, such as gamma radiation, X-rays or high-energy electron flux. Radiation can kill bacteria on the device and in the container. The sterilized device can then be stored in a sterile container for later use. The device can also be sterilized using any other method known in the art, including but not limited to beta or gamma radiation, ethylene oxide or steam.

After describing various embodiments of the present invention, further adaptation of the methods and systems described herein can be achieved by appropriately modifying one of those skilled in the art without departing from the scope of the present invention. Some of these potential changes have been mentioned, and others will be apparent to those skilled in the art. For example, the examples, variations, geometry, materials, sizes, coefficients, steps, and the like discussed above are illustrative and not required. Accordingly, the scope of the present invention should be considered in terms of the following requirements and understood, not limited to the details of the structure and operation shown and described in the specification and drawings.

Claims (8)

1. A circular surgical stapling instrument containing: (a) a cassette with brackets having a plurality of holes for the brackets; (b) a plurality of brackets, each of which is arranged to fit into the corresponding hole of the cassette with brackets, wherein the plurality of brackets are arranged around the cassette with brackets, and the plurality of brackets are pushed into the fabric, each of the plurality of brackets containing a back and legs extending from the back in the first direction, the back having a length defining a longitudinal direction and a width defining a transverse direction; (c) at least one tampon, each tampon made with the possibility of engaging the legs of the corresponding bracket from a plurality of brackets, and at least one tampon made with the possibility of sliding along the legs of the corresponding bracket in the direction of the back, and the width of at least one tampon is greater back width; (d) at least one flat protrusion associated with the at least one swab, and at least one flat protrusion extends outward from the at least one swab, and at least one flat protrusion is directed in the longitudinal or transverse direction with respect to to at least one tampon, characterized in that at least one tampon is arranged to be placed in a corresponding hole for the bracket and at least one flat protrusion is arranged to be placed outside the hole I brackets so that at least one flat projection is not passed through the hole for the bracket. 2. The tool of claim 1, wherein the at least one tampon contains at least a first and a second tampon, the cross section of the first tampon being larger than the cross section of the second tampon. 3. The tool according to claim 1, in which at least one tampon has a pair of holes made with the possibility of receiving the legs of the corresponding bracket. 4. The tool of claim 1, wherein said at least one flat protrusion comprises a combination of flat protrusions arranged transversely and flat protrusions arranged longitudinally.

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